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General NPI Number Information
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NPI Number | 1710983291
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Entity Type | Individual
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Provider Name | ARMIN JARED WAGMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 4350 S NATIONAL AVE # C-100
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City | SPRINGFIELD
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State | MO
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Zip | 65810-2607
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Country | US
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Telephone | 417-447-4700
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Fax | 417-447-4701
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Provider Business Mailing Address
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Address Line | 1301 CONCORD TER
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City | SUNRISE
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State | FL
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Zip | 33323-2843
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Country | US
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Telephone | 800-243-3839
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | R3P31
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License Number State | MO
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